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BackgroundDelivering self-management support to people with type 2 diabetes mellitus is essential to reduce the health system burden and to empower people with the skills, knowledge, and confidence needed to take an active role in managing their own health. ObjectiveThis study aims to evaluate the adoption, use, and effectiveness of the My Diabetes Coach (MDC) program, an app-based interactive embodied conversational agent, Laura, designed to support diabetes self-management in the home setting over 12 months. MethodsThis randomized controlled trial evaluated both the implementation and effectiveness of the MDC program. Adults with type 2 diabetes in Australia were recruited and randomized to the intervention arm (MDC) or the control arm (usual care). Program use was tracked over 12 months. Coprimary outcomes included changes in glycated hemoglobin (HbA1c) and health-related quality of life (HRQoL). Data were assessed at baseline and at 6 and 12 months, and analyzed using linear mixed-effects regression models. ResultsA total of 187 adults with type 2 diabetes (mean 57 years, SD 10 years; 41.7% women) were recruited and randomly allocated to the intervention (n=93) and control (n=94) arms. MDC program users (92/93 participants) completed 1942 chats with Laura, averaging 243 min (SD 212) per person over 12 months. Compared with baseline, the mean estimated HbA1c decreased in both arms at 12 months (intervention: 0.33% and control: 0.20%), but the net differences between the two arms in change of HbA1c (−0.04%, 95% CI −0.45 to 0.36; P=.83) was not statistically significant. At 12 months, HRQoL utility scores improved in the intervention arm, compared with the control arm (between-arm difference: 0.04, 95% CI 0.00 to 0.07; P=.04). ConclusionsThe MDC program was successfully adopted and used by individuals with type 2 diabetes and significantly improved the users’ HRQoL. These findings suggest the potential for wider implementation of technology-enabled conversation-based programs for supporting diabetes self-management. Future studies should focus on strategies to maintain program usage and HbA1c improvement. Trial RegistrationAustralia New Zealand Clinical Trials Registry (ACTRN) 12614001229662; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614001229662

Objective: We prospectively determined incident cardiovascular events and their association with risk factors in rural India. Methods: We followed up with 7935 adults from the Rishi Valley Prospective Cohort Study to identify incident cardiovascular events. Using Cox proportional hazards regression, we estimated hazard ratios (HRs) with 95% confidence intervals (95% CI) for associations between potential risk factors and cardiovascular events. Population attributable fractions (PAFs) for risk factors were estimated using R ('averisk' package). Results: Of the 4809 participants without prior cardiovascular disease, 57.7% were women and baseline mean age was 45.3 years. At follow‐up (median of 4.9 years, 23,180 person‐years [PYs]), 202 participants developed cardiovascular events, equating to an incidence of 8.7 cardiovascular events/1000 PYs. Incidence was greater in those with hypertension (hazard ratio [HR] [95% CI] 1.73 [1.21–2.49], adjusted PAF 18%), diabetes (1.96 [1.15–3.36], 4%) or central obesity (1.77 [1.23, 2.54], 9%) which together accounted for 31% of the PAF. Non‐traditional risk factors such as night sleeping hours and number of children accounted for 16% of the PAF. Conclusions: Both traditional and non‐traditional cardiovascular risk factors are important contributors to incident cardiovascular events in rural India. Interventions targeted to these factors could assist in reducing the incidence of cardiovascular events. [ABSTRACT FROM AUTHOR]

The self-collection of vaginal swabs and point-of-care testing and treatment of sexually transmitted infections (STIs) is reported from several low-and middle-income countries. However, the reporting on women's experiences of self-collection and same-day testing and treatment of STIs is less well described. In this paper, we present the acceptability of self-collected vaginal swabs and point-of-care testing and treatment among pregnant women enrolled in a clinical trial (Women and Newborn Trial of Antenatal Intervention and Management – WANTAIM) in Papua New Guinea. Semi-structured interviews were conducted among 54 women enrolled into WANTAIM to identify the acceptability of the test and treat approach. Analysis of qualitative data used deductive and inductive thematic analysis applying Sekhon, Cartwright and Francis' acceptability theoretical framework. Most women reported that they understood that the vaginal swab was to identify infections that may affect their unborn baby; however, some were unsure about the specific infections they were being tested for. Among women who tested positive for an STI, some were unsure what they had been treated for. Overall, the self-collection of vaginal swabs for STI testing during pregnancy was highly acceptable. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine whether samples of dried venous blood (DVB) were an acceptable alternative to serum for detecting measles-specific IgG in a commercial enzyme immunoassay. METHODS: Paired samples of serum and DVB were collected from 98 suspected cases of measles and 1153 schoolchildren in Victoria, Australia. All samples were tested using the Dade Behring Enzygnost® Anti-Measles-Virus/IgG immunoassay. DVB samples were eluted using either the sample buffer provided with the kit or 5% dry milk powder in phosphate-buffered saline-Tween 20. FINDINGS: DVB samples eluted by sample buffer showed significantly better linear correlation to the serum samples than did DVB samples eluted in 5% dry milk in phosphate-buffered saline-Tween 20. To improve the comparability of serum and DVB samples an adjustment factor of 1.28 was applied to the optical density (OD) values of DVB. This adjustment also enabled quantification of the titre of measles IgG in mIU/ml directly from the OD value using the alpha calculation as specified by the kit protocol. For DVB samples stored for less than six months at 4 °C, the assay showed an overall sensitivity of 98.4% and a specificity of 97.2% compared with the results of serum testing. CONCLUSION: These results illustrate the potential for DVB samples to be widely used with the Dade Behring enzyme immunoassay system for determining the immunity of the individual and the population to the measles virus.

Elimination of endemic measles transmission is the culmination of a range of control measures at a national level. Current documentation of elimination proposed by WHO's regional offices requires achieving specific targets for surveillance process indicators. We demonstrate how Australia, although not meeting these specific targets, has satisfied multiple criteria that justify the formal declaration of measles elimination. Our review shows that few countries previously declaring measles elimination-have satisfied the current WHO surveillance targets. We argue that the requirements for recognition of measles elimination should not restrict countries to a particular type of surveillance system or surveillance criteria. L'elimination de la transmission endemique de la rougeole est le point culminant d'une serie de mesures de lutte contre cette maladie au niveau national. Pour attester de l'elimination de la rougeole, les Bureaux regionaux de l'OMS proposent actuellement que les indicateurs servant a la surveillance aient atteint des objectifs specifiques. Nous demontrons comment l'Australie, bien que n'ayant pas atteint ces objectifs, a rempli plusieurs criteres justifiant la declaration formelle de l'elimination de la rougeole. Notre analyse montre que peu de pays ayant anterieurement declare la rougeole comme eliminee ont rempli les objectifs actuels en matiere de surveillance de l'OMS. A notre avis, les exigences pour reconnaitre l'elimination de la rougeole ne devraient pas imposer aux pays l'utilisation d'un type particulier de systeme ou de critere pour la surveillance. La eliminacion de la transmision endemica del sarampion supone la culminacion de toda una serie de medidas de control desplegadas a nivel nacional. La actual documentacion sobre la eliminacion propuesta por las oficinas regionales de la OMS requiere que se alcancen metas concretas para los indicadores del proceso de vigilancia. Explicamos aqui de que manera Australia, si bien no ha alcanzado esas metas especificas, ha satisfecho muchos criterios que justifican la declaracion oficial de eliminacion del sarampion. Nuestro analisis muestra que, entre los paises que han declarado haber eliminado esta enfermedad, son pocos los que han alcanzado las actuales metas de vigilancia de la OMS. Se argumenta que, entre los requisitos para el reconocimiento de la eliminacion del sarampion, no se debe exigir a los paises que apliquen solo un sistema de vigilancia o unos criterios de vigilancia determinados., Defining elimination Several WHO regions have set target dates for the elimination of the transmission of endemic measles. The WHO Regional Office for the Western Pacific (WPRO) has nominated the [...]

Objective: To determine the proportion of Victorian primary school students protected against measles infection one year after the completion of the measles `catch-up' immunisation campaign of 1998 and to compare this with the proportion of year 9 and 10 (aged 14-16 years) students. Design & setting: Three-stage random cluster survey in Victorian primary and secondary schools. Main outcome measures: Proportion of primary and year 9 and 10 secondary school students protected against measles infection one year after the completion of the mass `catch-up' immunisation campaign. Secondary outcomes: the proportion of both primary and year 9 and 10 secondary school students protected against both mumps and rubella. Results: Of 1,037 Victorian primary and 2,357 years 9 and 10 secondary school students invited to participate in this study, 403 (39%) and 752 (32%) respectively provided a blood specimen for serological testing for antibodies against measles, mumps and rubella. 94.8% (95% confidence interval, 91.5, 96.9) of primary school and 93.1% (90.9, 94.8) of year 9 and 10 students were protected against measles infection. Conclusion: One year after the completion of the school-based measles `catch-up' immunisation campaign the level of protection in Victorian primary school aged students is sufficient to prevent the continuing circulation of measles virus within this age group. The proportion of year 9 and 10 secondary school students protected against measles is also probably sufficient to prevent continuing circulation of wild type virus in Victoria, even though this age group was not specifically targeted by the `catch-up' campaign.